Feasibility Study of Developing a Saline-Based Antiviral Nanoformulation Containing Lipid-Soluble EGCG: A Potential Nasal Drug to Treat Long COVID.

A recent estimate indicates that up to 23.7 million Americans suffer from long COVID, and approximately one million workers may be out of the workforce each day due to associated symptoms, leading to a USD 50 billion annual loss of salary. Post-COVID (Long COVID) neurologic symptoms are due to the initial robust replication of SARS-CoV-2 in the nasal neuroepithelial cells, leading to inflammation of the olfactory epithelium (OE) and the central nervous system (CNS), and the OE becoming a persistent infection site. Previously, our group showed that Epigallocatechin-3-gallate-palmitate (EC16) nanoformulations possess strong antiviral activity against human coronavirus, suggesting this green tea-derived compound in nanoparticle formulations could be developed as an intranasally delivered new drug to eliminate the persistent SARS-CoV-2 infection, leading to restored olfactory function and reduced inflammation in the CNS. The objective of the current study was to determine the compatibility of the nanoformulations with human nasal primary epithelial cells (HNpECs). METHODS: Nanoparticle size was measured using the ZetaView Nanoparticle Tracking Analysis (NTA) system; contact antiviral activity was determined by TCID50 assay for cytopathic effect on MRC-5 cells; post-infection inhibition activity was determined in HNpECs; and cytotoxicity for these cells was determined using an MTT assay. The rapid inactivation of OC43 (a ß-coronavirus) and 229E (α-coronavirus) viruses was further characterized by transmission electron microscopy. RESULTS: A saline-based nanoformulation containing 0.1% w/v EC16 was able to inactivate 99.9999% ß-coronavirus OC43 on direct contact within 1 min. After a 10-min incubation of infected HNpECs with a formulation containing drug-grade EC16 (EGCG-4' mono-palmitate or EC16m), OC43 viral replication was inhibited by 99%. In addition, all nanoformulations tested for their effect on cell viability were comparable to normal saline, a regularly used nasal irrigation solution. A 1-min incubation of an EC16 nanoformulation with either OC43 or 229E showed an altered viral structure. CONCLUSION: Nanoformulations containing EC16 showed properties compatible with nasal application to rapidly inactivate SARS-CoV-2 residing in the olfactory mucosa and to reduce inflammation in the CNS, pending additional formulation and safety studies.

Scarcity in abundance? Spatial inequalities in Rheumatoid Arthritis in a health system with financial equity.

BACKGROUND: This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS: We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS: The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS: There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

Optimization of PVDF-TrFE Based Electro-Conductive Nanofibers: Morphology and In Vitro Response.

In this study, morphology and in vitro response of electroconductive composite nanofibers were explored for biomedical use. The composite nanofibers were prepared by blending the piezoelectric polymer poly(vinylidene fluoride-trifluorethylene) (PVDF-TrFE) and electroconductive materials with different physical and chemical properties such as copper oxide (CuO), poly(3-hexylthiophene) (P3HT), copper phthalocyanine (CuPc), and methylene blue (MB) resulting in unique combinations of electrical conductivity, biocompatibility, and other desirable properties. Morphological investigation via SEM analysis has remarked some differences in fiber size as a function of the electroconductive phase used, with a reduction of fiber diameters for the composite fibers of 12.43% for CuO, 32.87% for CuPc, 36.46% for P3HT, and 63% for MB. This effect is related to the peculiar electroconductive behavior of fibers: measurements of electrical properties showed the highest ability to transport charges of methylene blue, in accordance with the lowest fibers diameters, while P3HT poorly conducts in air but improves charge transfer during the fiber formation. In vitro assays showed a tunable response of fibers in terms of viability, underlining a preferential interaction of fibroblast cells to P3HT-loaded fibers that can be considered the most suitable for use in biomedical applications. These results provide valuable information for future studies to be addressed at optimizing the properties of composite nanofibers for potential applications in bioengineering and bioelectronics.

New Insights to Design Electrospun Fibers with Tunable Electrical Conductive-Semiconductive Properties.

Fiber electronics, such as those produced by the electrospinning technique, have an extensive range of applications including electrode surfaces for batteries and sensors, energy storage, electromagnetic interference shielding, antistatic coatings, catalysts, drug delivery, tissue engineering, and smart textiles. New composite materials and blends from conductive-semiconductive polymers (C-SPs) offer high surface area-to-volume ratios with electrical tunability, making them suitable for use in fields including electronics, biofiltration, tissue engineering, biosensors, and "green polymers". These materials and structures show great potential for embedded-electronics tissue engineering, active drug delivery, and smart biosensing due to their electronic transport behavior and mechanical flexibility with effective biocompatibility. Doping, processing methods, and morphologies can significantly impact the properties and performance of C-SPs and their composites. This review provides an overview of the current literature on the processing of C-SPs as nanomaterials and nanofibrous structures, mainly emphasizing the electroactive properties that make these structures suitable for various applications.

Electrospinning Technique for Fabrication of Coaxial Nanofibers of Semiconductive Polymers.

In this work, the electrospinning technique is used to fabricate a polymer-polymer coaxial structure nanofiber from the p-type regioregular polymer poly(3-hexylthiophene-2,5-diyl) (P3HT) and the n-type conjugated ladder polymer poly(benzimidazobenzophenanthroline) (BBL) of orthogonal solvents. Generally, the fabrication of polymeric coaxial nanostructures tends to be troublesome. Using the electrospinning technique, P3HT was successfully used as the core, and the BBL as the shell, thus conceptually forming a p-n junction that is cylindrical in form with diameters in a range from 280 nm to 2.8 µm. The UV-VIS of P3HT/PS blend solution showed no evidence of separation or precipitation, while the combined solutions of P3HT/PS and BBL were heterogeneous. TEM images show a well-formed coaxial structure that is normally not expected due to rapid reaction and solidification when mixed in vials in response to orthogonal solubility. For this reason, extruding it by using electrostatic forces promoted a quick elongation of the polymers while forming a concise interface. Single nanofiber electrical characterization demonstrated the conductivity of the coaxial surface of ~1.4 × 10-4 S/m. Furthermore, electrospinning has proven to be a viable method for the fabrication of pure semiconducting coaxial nanofibers that can lead to the desired fabrication of fiber-based electronic devices.

The addition of body weight supported treadmill training to manual therapy and exercise in the management of Hip osteoarthritis: A case series.

BACKGROUND AND PURPOSE: Patients with mild-to-moderate hip OA can present with pain, a decline in function, altered gait mechanics, and pain with ambulation. Body weight supported treadmill training (BWSTT) has been utilized for patients with total hip arthroplasty, hip fracture, and lumbar spinal stenosis. The purpose of this case series was to report the outcomes of patients with hip OA that received guideline adherent physical therapy care with the addition of BWSTT. Our aim was to assess changes in pain, disability, and physical performance. CASE DESCRIPTIONS: Seven patients participated in eight 1-h treatment sessions consisting of: manual therapy, therapeutic exercise, and BWSTT. Pre- and post-treatment outcome measures included: average pain rating via the Numeric Pain Rating Scale (NPRS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Global Rate of Change (GROC). Physical performance measures included: 6-minute walk test (6MWT), stair climbing test, and 5 time sit-stand. OUTCOMES: The mean improvement in NPRS score for all subjects was 2.9 points. Mean improvement on the WOMAC was 18.5 + 24.8 pts, and the mean GROC score was +5.0 indicating a rating of "quite a bit better." The mean increase in 6MWT distance was 60.5 + 80.1 meters (median 39 m, range -3 to 230). CONCLUSIONS: Though patients participating in a multimodal rehabilitation approach including manual therapy, exercise, and BWSTT demonstrated clinically important improvements in pain and function, these changes may not correspond with gait endurance improvements in the short term.

Transcultural Adaptation and Psychometric Support for a Brazilian Portuguese Version of the Flow State Scale (FSS-2).

The flow experience in sports is a construct of great interest to recreational and competitive athletes, coaches, and psychologists in pursuit of optimal performance. As there are no validated instruments for evaluating flow in the Brazilian Portuguese language, we evaluated the psychometric properties of a Brazilian version of the Flow State Scale (FSS-2) through three steps. Initially, four translators and five sports psychology specialists adapted the FSS-2 content for the Brazilian Portuguese language. Second, 371 athletes of both sexes who were engaged in group and individual sport modalities and who participated in national university sports competitions from 24 states responded to the adapted version of the FSS-2. Third, an independent sample of 34 athletes from Paraná responded to both the adapted FSS-2 and the dispositional flow scale (DFS-2) to permit analysis of the external validity and temporal stability of the adapted FSS-2. We found that the Brazilian version of the FSS-2 contains clear and pertinent items with a good content validity coefficient (CVC = 0.94) and satisfactory internal consistency (α > 0.88/CC > 0.80). Confirmatory factor analysis revealed that the adapted 36-item model presented adequate fit [X2 (558) = 1258.85; X2/df = 2.256; comparative fit index (CFI) = 0.92; non-normed fit index (NNFI) = 0.90; Tucker-Lewis Index (TLI) = 0.91; root mean square error of approximation (RMSEA) = 0.06 (0.05-0.06); (RMSEA <0.05) =.001] with all first order factors (challenge-skills balance, action-attention fusion, clear goals, feedback, intense concentration, control, loss of self-awareness, time transformation, and autotelic experience). External validity (r > 0.344) and temporal stability (0.53 < intraclass correlation coefficient (ICC) < 0.86) were satisfactory. We conclude that the Brazilian version of FSS-2 is adequate to evaluate flow states experienced by Brazilian athletes following a sports competition.

Mycotic Pseudoaneurysm Formation at the Cannulation Site in the Ascending Aorta.

The formation of mycotic pseudoaneurysms in the ascending aorta is a rare but sometimes fatal complication after open-heart surgery, requiring cardiopulmonary bypass (CPB). There has been little cited about this rare complication. We present a case of a 51-year-old man who developed a mycotic pseudoaneurysm in the ascending aorta at a previous aortic cannulation site nine years after coronary artery bypass surgery. The patient presented to the emergency department with two weeks of worsening substernal chest pain and was found to have pseudoaneurysm in the anterior wall of the ascending aorta on chest computed tomography angiography (CTA) during his chest pain workup. The patient's blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA). During the hospital course, the patient's respiratory status worsened, and repeat CTA revealed enlargement of the pseudoaneurysm arising from the anterior proximal arch of the aorta. Chest X-ray obtained because of hypoxia demonstrated widening of the upper mediastinum, which appeared increased compared with the previous exam. Because of concern for rupture of an aneurysm, the patient was taken to the operating room for redo sternotomy and repair of the pseudoaneurysm with femoral artery cannulation for cardiopulmonary bypass. The patient completed eight weeks of IV nafcillin, and rifampin was added to decrease biofilm formation.

Plant traits and vegetation data from climate warming experiments along an 1100 m elevation gradient in Gongga Mountains, China.

Functional trait data enhance climate change research by linking climate change, biodiversity response, and ecosystem functioning, and by enabling comparison between systems sharing few taxa. Across four sites along a 3000-4130 m a.s.l. gradient spanning 5.3 °C in growing season temperature in Mt. Gongga, Sichuan, China, we collected plant functional trait and vegetation data from control plots, open top chambers (OTCs), and reciprocally transplanted vegetation turfs. Over five years, we recorded vascular plant composition in 140 experimental treatment and control plots. We collected trait data associated with plant resource use, growth, and life history strategies (leaf area, leaf thickness, specific leaf area, leaf dry matter content, leaf C, N and P content and C and N isotopes) from local populations and from experimental treatments. The database consists of 6,671 plant records and 36,743 trait measurements (increasing the trait data coverage of the regional flora by 500%) covering 11 traits and 193 plant taxa (ca. 50% of which have no previous published trait data) across 37 families.

Chondroblastoma of the Distal Femur in an Adolescent.

An 11-year-old female was referred to physical therapy due to a 3-month history of right medial knee pain. The patient's medical diagnosis was Osgood-Schlatter disease, based on radiographs obtained at the initial pediatrician consultation. An MRI scan was obtained 2 weeks after starting physical therapy and revealed a bony lesion near the medial condyle of the right femur and damage to medial joint structures. Pathology after open biopsy and curettage of the lesion revealed a chondroblastoma. J Orthop Sports Phys Ther 2020;50(5):275. doi:10.2519/jospt.2020.9021.

An orthopedic manual physical therapy fellowship training's impact on professional development, involvement, personal lives, and income - A survey study.

Introduction: Little research exists investigating the personal and professional outcomes of postprofessional physical therapy (PT) training. Therefore, the purpose of the current descriptive, web-based survey study was to determine self-reported outcomes from a postprofessional PT fellowship program, including graduate professional, educational, and research involvement; perceptions of the impact of training on clinical and professional attributes; changes in employment and income; and barriers to training. Methods: Graduates of a part-time, hybrid-model, multisite orthopedic manual PT fellowship program were invited to complete the web-based survey. Descriptive data analyses were performed for all quantitative data, and responses to questions were analyzed and categorized into themes. Results: Of the 77 fellowship graduates, 75 (97%) completed the survey. Graduates were involved in teaching; 43% (32/75) filled lead instructor roles in PT education programs. Further, 75% (57/75) were involved in research. The mean (SD) and median (range) increase in annual gross income was $9560 ($17,545) and $2,500 ($0-$125,000), respectively. Perceived areas with the largest impact of training included clinical reasoning, patient-centered and evidence-based practice, and professionalism. Life balance and family commitments were frequent barriers during training. Discussion: Graduates noted substantial perceived professional, clinical, and financial benefits to fellowship training. Limitations included lack of a control group and surveying participants from a single program. Future research should determine the influence that program and participant-related factors have on personal and professional lives of graduates and on clinical outcomes. Level of Evidence: Descriptive survey, level 3.

A Neurovisceral Integrative Study on Cognition, Heart Rate Variability, and Fitness in the Elderly.

The association between physical fitness and cognitive performance has been widely investigated in the literature. However, the neurophysiological mechanisms underlying this relationship are not yet clear. Here, we aim to evaluate the interactions between executive function measures, heart rate variability (HRV), and physical fitness in the context of the neurovisceral integration (NVI) theory. Twenty-eight healthy elderly subjects (>60 years) were submitted to evaluation of executive performance with three computerized tests: the N-back test measured working memory capacity, the Stroop Color test evaluated inhibitory control and selective attention, and the Wisconsin Card Sorting Test (WCST) evaluated abstract reasoning and cognitive flexibility. We also used the Physical Testing Battery for the Elderly to measure aerobic capacity, dynamic balance, upper body flexibility, and handgrip strength. Our results confirm the relationship between executive function and physical fitness, particularly between working memory, cardiorespiratory fitness, and dynamic balance. We also demonstrate an association between executive performance and HRV in older people, corroborating previous results from other groups obtained in young adults. However, our regression models did not indicate that HRV mediates the relationship between cognition and physical fitness in the elderly, suggesting that age-related degeneration of autonomic control can affect aspects of NVI in this population.

Mutation Screening in the miR-183/96/182 Cluster in Patients With Inherited Retinal Dystrophy.

Inherited retinal dystrophy (IRD) is a heterogenous blinding eye disease and affects more than 200,000 Americans and millions worldwide. By far, 270 protein-coding genes have been identified to cause IRD when defective. However, only one microRNA (miRNA), miR-204, has been reported to be responsible for IRD when a point-mutation occurs in its seed sequence. Previously, we identified that a conserved, polycistronic, paralogous miRNA cluster, the miR-183/96/182 cluster, is highly specifically expressed in all photoreceptors and other sensory organs; inactivation of this cluster in mice resulted in syndromic IRD with multi-sensory defects. We hypothesized that mutations in the miR-183/96/182 cluster in human cause IRD. To test this hypothesis, we perform mutation screening in the pre-miR-183, -96, -182 in >1000 peripheral blood DNA samples of patients with various forms of IRD. We identified six sequence variants, three in pre-miR-182 and three in pre-miR-96. These variants are in the pre-miRNA-182 or -96, but not in the mature miRNAs, and are unlikely to be the cause of the IRD in these patients. In spite of this, the nature and location of these sequence variants in the pre-miRNAs suggest that some may have impact on the biogenesis and maturation of miR-182 or miR-96 and potential roles in the susceptibility to diseases. Although reporting on negative results so far, our study established a system for mutation screening in the miR-183/96/182 cluster in human for a continued effort to unravel and provides deeper insight into the potential roles of miR-183/96/182 cluster in human diseases.

Exercise and Low Back Pain in the Older Adult: Current Recommendations.

Low back pain (LBP) is a condition that is commonly experienced in people regardless of age and is prevalent in the older adult (individuals >65 yrs). Unfortunately, LBP research frequently excludes the older adult population due to age related co-morbidities. Clinical decision-making for this patient population is thus affected. As such, exercise prescription must be extrapolated from the available literature focused on chronic LBP, older adults without LBP, and younger adults with LBP. The aim of this paper is to review common exercise paradigms including strength, aerobic, and motor control training for treating LBP while discussing potential considerations in exercise prescription for the older adult population. Aside from previous episodes of LBP, predictive factors for development of LBP include poor back muscle endurance, perceived disability, depression/anxiety, fear avoidance, catastrophizing, and illness perception. Exercise is often considered unsafe in the older adult; however, there have been no reported serious cardiovascular incidents with exercise in the older adult from ages 80-100. While there is no clear superior exercise paradigm for the older adult with LBP, there is evidence that the older adult benefits from exercise in general. In addition, these benefits do not decrease with age.

Dispositional Flow and Performance in Brazilian Triathletes.

Flow is a mental state characterized by total immersion and focus in an activity; performing it pleasurably. Such a state is considered optimal for performance. The present study analyzed the relationship between dispositional flow and performance in triathletes. The sample consisted of 328 athletes (294 males and 34 females; mean age of 37.42 ± 7.18 years) competing in the Ironman Brazil - Florianópolis - South American Championship 2017. Instruments were an identification sheet, the Dispositional Flow Scale (DFS-2) and athletes' total race times. Data were analyzed using R, through the Shapiro-Wilk normality test, Mann-Whitney's U, Spearman Correlation, and Network Analysis [Least Absolute Shrinkage and Selection Operator (LASSO)], using strength, closeness, and betweenness as centrality measurements. Results show a positive correlation between age and practice time (r = 0.34), inverse relationship between practice time and total race time (r = -0.25), and inverse correlations between race time and 05 of the 09 flow dimensions (r between -0.17 and -0.11), suggesting better performances were related to more practice time and higher disposition to flow. Flow conditions, flow characteristics, individual characteristics, and performance were separately grouped in the network structure. Challenge-skill balance was the most influential node, with the highest closeness and betweenness values; challenge-skill balance, clear goals, control, and action-awareness merge directly influenced better race times. Sample's top 50 performers had significantly higher disposition to challenge-skill balance, clear goals, control and feedback. Practical implications of flow mechanisms are discussed. Dispositional flow was positively related to objective performance in Brazilian triathletes.

Pituitary gigantism: a case series from Hospital de San José (Bogotá, Colombia).

INTRODUCTION: Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. MATERIALS AND METHODS: Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. RESULTS: All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. CONCLUSIONS: This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.

Pituitary gigantism: a case series from Hospital de San José (Bogotá, Colombia)

ABSTRACT Introduction Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. Materials and methods Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. Results All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. Conclusions This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.

Significance of Nanomaterials in Wearables: A Review on Wearable Actuators and Sensors.

Together with the evolution of digital health care, the wearable electronics field has evolved rapidly during the past few years and is expected to be expanded even further within the first few years of the next decade. As the next stage of wearables is predicted to move toward integrated wearables, nanomaterials and nanocomposites are in the spotlight of the search for novel concepts for integration. In addition, the conversion of current devices and attachment-based wearables into integrated technology may involve a significant size reduction while retaining their functional capabilities. Nanomaterial-based wearable sensors have already marked their presence with a significant distinction while nanomaterial-based wearable actuators are still at their embryonic stage. This review looks into the contribution of nanomaterials and nanocomposites to wearable technology with a focus on wearable sensors and actuators.

Nueva Delhi metalo--ß--lactamasa en especies de Enterobacteriaceae aisladas de pacientes hospitalizados, Managua, Nicaragua / New Delhi Metallo--ß-lactamase in Enterobacteriaceae species isolated from hospitalized patients, Managua Nicaragua

Resumen Objetivo: determinar la frecuencia de metalo-β lactamasa tipo Nueva Delhi (NDM), en aislados de enterobacterias provenientes de pacientes hospitalizados con diferentes procesos infecciosos. Método: se realizó una investigación descriptiva transversal, agosto 2015 - octubre 2016, en el Hospital Alemán Nicaragüense. Se estudiaron 249 cepas en vigilancia activa a los carbapenémicos. La identificación y perfil de resistencia se efectuó en Vitek2; la sospecha de resistencia a los carbapenémicos se tomó cuando la CMI de Imipenem y Meropenem 2-4 μg/mL y Ertapenem 2 μg/mL, se determinó mediante Kirby Bauer, el test de sinergia triple disco (carbapenémicos y EDTA 10µg); se hizo la reacción en cadena de la polimerasa para metalo-β-lactamasa Nueva Delhi. Resultados: se analizaron 249 cepas, entre estas se identificó 45 cepas resistentes a los carbapenémicos, correspondiendo al 18%. De estas cepas, 43 dieron positivo para el test de sinergia con EDTA; 21 portaban el gen de Nueva Delhi. El 66% de metalo-β-lactamasa Nueva Delhi se encontró en aislamientos de Klebsiella pneumoniae, seguida de Escherichia vulneris en un 14%, Escherichia coli en un 5%, Providencia rettgeri en un 5%, Pantoea agglomerans en un 5% y Kluyvera cryocrescens en un 5%.19 Conclusiones: el hallazgo del presente estudio es una advertencia clara sobre la circulación de cepas de metalo-β-lactamasa tipo Nueva Delhi que codifican la resistencia a los carbapenémicos en el hospital analizado.

Abstract Objective: to determine the frequency of New Delhi-type metallo-β-lactamase (NDM) in isolates of enterobacteria from patients hospitalized with different infectious processes. Method: a cross-sectional descriptive study was carried out between August 2015 and October 2016 at Alemán Nicaragüense Hospital. A total of 249 strains were studied in active surveillance of carbapenems resistance. The identification and resistance profile was carried out in Vitek2. Suspected resistance to carbapenems was considered when the MIC of Imipenem and Meropenem was 2-4 μg/mL and for Ertapenem of 2 μg/mL, determined by Kirby Bauer, the triple disc synergy test (carbapenems and EDTA 10μg). A polymerase chain reaction test was made to determinate New Delhi metallo-β lactamase. Results: a total of 249 strains were analyzed, among which 45 strains resistant to carbapenems were identified, corresponding to 18%. Of these strains, 43 were positive for the synergy test with EDTA; 21 carried the New Delhi gene. Of the New Delhi metallo-β lactamase. 66% were found in isolates of Klebsiella pneumoniae, followed by Escherichia vulneris in 6 isolates, Escherichia coli in 2, Providencia rettgeri in 2, Pantoea agglomerans in 2 and Kluyvera cryocrescens by 2. Conclusions: the results of the present study are a clear warning about the circulation of New Delhi-type metallo-β-lactamase strains that codify for the resistance to carbapenems in the hospital analyzed.

Análisis de costo-efectividad de lanreótide, octreótide y cabergolina para el tratamiento de pacientes con acromegalia en Colombia / Cost-effectiveness analysis of lanreotide, octreotide and cabergoline for the treatment of patients with acromegaly in Colombia

Problema de investigación: Calcular los costos y la efectividad esperados de lanreótide, octreótide y cabergolina para el tratamiento de pacientes con diagnóstico de gigantismo o acromegalia no candidatos al tratamiento quirúrgico en Colombia. Tipo de evaluación económica: Evaluación de costo-efectividad. Población objetivo: Pacientes con diagnóstico de gigantismo o acromegalia no candidatos al tratamiento quirúrgico en Colombia. Intervención y comparadores: Se comparan los tratamientos farmacológicos octreótide, lanreótide y cabergolina. Horizonte temporal: 18 meses de observación, de acuerdos a los estudios de seguimiento de las tecnologías.Perspectiva: Sistema general de seguridad social en salud. Tasa de descuento: Dado el horizonte temporal de 18 meses no se emplea tasa de descuento. Estructura del modelo: Árbol de decisión. Fuentes de datos de efectividad y seguridad: Se parte del informe de seguridad y efectividad de las tecnologías (1), se complementa la información con meta-análisis y revisiones sistemáticas de literatura, de acuerdo a la población y tecnologías de la pregunta de investigación. Desenlaces y valoración: Años de vida ajustados por calidad. Costos incluidos: Costos directos del tratamiento de acuerdo a las alternativas evaluadas, seguimiento de los pacientes y comorbilidades asociadas a la enfermedad cuando no se hace un adecuado control de síntomas. Fuentes de datos de costos: Para medicamentos SISMED, para procedimientos tarifario ISS2001 + 30% y tarifario SOAT 2014. Resultados del caso base: Tomando como caso base como control de síntomas: normalización de IGFI y HC, el octreótide es la estrategia menos costosa y más efectiva. Análisis de sensibilidad: No existe una diferencia estadísticamente significativa en efectividad entre octreótide y lanreótide, los dos medicamentos se encuentran bajo regulación de precios por lo que los costos también son similares. Al realizar análisis de sensibilidad univariados sobre las\r\nprobabilidades de control de síntomas, la relación de dominancia de octreótide desaparece. También se realizaron las estimaciones solo teniendo en cuenta como control de síntomas la normalización de los\r\nniveles de IGFI para este caso es el lanreótide el que resulta ser menos costoso y más efectivo. Cabergolina se estudia dentro de un análisis de subgrupos dentro de la población señalada y no se realizan análisis de sensibilidad sobre los resultados de esta tecnología. Conclusiones y discusión: Si bien se planteó al inicio del estudio la comparación entre octreótide, lanreótide y cabergolina de acuerdo al marco del estudio de efectividad y seguridad (1) y con los expertos consultados. En el desarrollo de la investigación fue necesario aclarar que cabergolina es una tecnología usada en pacientes que representan una minoría dentro de la población de estudio, teniendo en cuenta lo anterior se abordó el uso de cabergolina como un análisis de subgrupos y se continuó con la estimación de la razón de costo-efectividad de lanreótide y octreótide. \r\nOctreótide es la alternativa menos costosa y más efectiva si se toma como control de síntomas la normalización de IGFI+HC. Sin embargo, si solo se estima la razón de costo-efectividad con la normalización de IGFI, lanreótide resulta ser la estrategia dominante. Dados los resultados no es posible concluir que una u\r\notra alternativa entre octreótide o lanreótide domine a su comparador.(AU)